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Montana rates for HCPCS A5513

For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $30.20 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $56.23 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $56.23 / $56.23
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $52.48 / $102.33
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $52.48 / $102.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $50.12 / $64.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $56.23 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $38.02 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $24.55 / $38.90